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目的观察局部枸橼酸钠抗凝在有严重出血倾向危重症连续血液净化(continuous blood purification,CBP)患儿中应用的安全性与有效性。方法对2015年3月至2016年5月山东大学齐鲁儿童医院收治的11例因不同疾病引起的严重出血倾向及严重肝功能障碍患儿,进行CBP治疗时采用局部枸橼酸钠抗凝。监测CBP治疗前后活化凝血时间(ACT)、血清钙离子及动脉血气变化,观察患儿临床出血表现及滤器运行状况。结果应用局部枸橼酸钠治疗中滤器后ACT值较滤器前有明显延长,治疗中与治疗前滤器前的ACT值无明显变化。治疗中滤器后钙离子较滤器前明显降低,其中2例滤器后钙离子曾低于0.2 mmol/L,予减慢枸橼酸溶液滴速纠正。11例均未发生严重出血及原有出血加重情况,均完成了CBP治疗。结论局部枸橼酸钠抗凝在儿科危重症CBP中的临床效果值得肯定,对全身凝血影响小。可以作为临床有严重出血倾向及肝功能障碍、不宜采用肝素抗凝的危重患儿进行CBP治疗时的抗凝选择。
Objective To investigate the safety and efficacy of local sodium citrate anticoagulation in children with severe bleeding tendency critical continuous blood purification (CBP). Methods From March 2015 to May 2016, 11 children with severe bleeding disorder and severe liver dysfunction due to various diseases admitted to Qilu Children’s Hospital of Shandong University were treated with local sodium citrate anticoagulation during CBP. The activated clotting time (ACT), serum calcium and arterial blood gas were monitored before and after CBP treatment. The clinical manifestations of bleeding and the filter operating status were observed. Results The results showed that the ACT value of local sodium citrate treatment was significantly longer than that before the filter. There was no significant change in ACT before treatment and before treatment. Calcium ions in the treatment of the filter was significantly lower than the filter, of which two cases of calcium after the filter had less than 0.2 mmol / L, to slow down the citric acid solution drip correction. All 11 cases had no serious bleeding and the original bleeding aggravate, have completed the CBP treatment. Conclusion The clinical effect of local sodium citrate anticoagulation in pediatric critically ill CBP is worthy of recognition and has little effect on systemic coagulation. Can be used as clinically severe bleeding tendency and liver dysfunction, should not be used in patients with critical heparin anticoagulation CBP anticoagulant selection.